Fentanyl a rising factor in Connecticut overdose deaths

‘Most potent synthetic opioid that we make’

Published 9:09 pm, Sunday, February 28, 2016

Photo: Journal Register Co.

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This photo provided by the North Haven Police Department was released after two Hartford women were arrested in November when police allegedly caught them trying to deliver 250 bags of a heroin and Fentanyl mixture. Fentanyl is a prescription drug that amplifies the effects of heroin and cocaine and North Haven police said it has led to a spike in overdoses in the town over the past year. less

This photo provided by the North Haven Police Department was released after two Hartford women were arrested in November when police allegedly caught them trying to deliver 250 bags of a heroin and Fentanyl ... more

Photo: Journal Register Co.

Fentanyl a rising factor in Connecticut overdose deaths

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Fentanyl, a synthetic painkiller commonly used to cut heroin, was detected in 186 Connecticut overdose deaths in 2015.

But what is fentanyl, exactly? Dr. Gail D’Onofrio, chief of the emergency department at Yale-New Haven Hospital, compared it to morphine — only 50 to 100 times more potent.

“This is the most potent synthetic opioid that we make,” D’Onofrio said.

In the hospital — especially the emergency room — fentanyl is commonly used the same way that morphine is: for acute or chronic, severe pain or major trauma. Not all doctors can administer it and when it is used, it is regulated and monitored by a “skilled practitioner.”

A patient’s airway is monitored, D’Onofrio said, as is oxygen saturation, CO2 production and other factors.

The drug is fast acting and powerful, which makes it a natural fit for a patient dealing with major trauma. One of the side effects of the drug, D’Onofrio said, is euphoria.

“People have no idea how strong this drug is, especially people using street drugs. They have no idea the potency of this medication and the risk they are taking,” D’Onofrio said.

Cutting

In the drug trade, fentanyl is what is known as an adulterate: a cutting agent. “Cutting” is the process of diluting a drug. A dealer, for instance, will take a portion of heroin and mix it with drugs such as inositol or quinine or common powdered substances such as starch, molasses, coffee, cocoa mix or powdered milk.

“The process of cutting is adding another powdered chemical to a drug to make more, so you can sell more for less,” said Sgt. Karl Jacobson, Criminal Intel Unit supervisor for the New Haven Police Department.

According to Connecticut State Police, glucose, procaine and molasses have been used to cut heroin, as well as sheep laxatives and sheep de-wormer.

In 18 years on the job, both in Connecticut and with the East Providence Police Department in Rhode Island, Jacobson said he’s never seen the arrest of a fentanyl dealer, if there is such a thing. Fentanyl has “been around” his whole career, Jacobson said, but is on the rise in use in Connecticut, especially in the past two or three years.

State police Lt. Mark Sticca, area commander of the Statewide Narcotics Task Force, said there are illicit fentanyl labs in Mexico and elsewhere. But neither he nor Jacobson has encountered any in Connecticut. Both noted “your regular drug capitals,” as Jacobson put it, such as Mexico and the Dominican Republic, as sources for heroin and fentanyl getting into the country.

Further, some of the fentanyl is stolen or sold illegally and some is manufactured illegally using raw products, Sticca said. He said there are large fentanyl mills in Mexico.

Heroin hits the street already cut, often in a glassine bag, the same material used for stamp bags. Jacobson said that while raiding dealers’ houses in the past, it was common to find dozens of stamp bags stashed in the residence. He’d ask, “Oh, you collect stamps?” of people in the house.

Shipments of heroin come in already marked, Jacobson said, almost like brand names. They are stamped with labels reading “007,” “Harley-Davidson,” “Serial Killer” or “Netflix.” Heroin laced with fentanyl is known on the street as “china white,” “poison,” or “TNT.”

“Sometimes there’s no method to the madness, the same guy could have five different stamps. Other times there’s different quality of heroin based on what’s stamped on the bag,” Jacobson said.

“They might push the sales by someone saying ‘It’s laced with fentanyl, you’ll get a better high,’” he said.

Dealers will sometimes try to copy one another, printing similar images onto their products. It’s part of the game, Jacobson said.

Heroin cut with fentanyl also can enter the United States pre-packaged together, Sticca said, in a kilo. However, there is no way to tell if the fentanyl is evenly spread out throughout the kilo. One part of the package could have a large portion of the fentanyl.

“We’re not talking controlled experimentation here,” Sticca said.

Drug of the moment

“I know of stories where people have done heroin and immediately said afterwards, ‘Oh, this was fentanyl!’ I think addicts kind of know their drugs,” Jacobson said.

But they may not know fentanyl is present in the drug when making the purchase. Some don’t really care, Jacobson said. Others will actively seek it out.

“It’s all about the rush,” he said.

Heroin is the drug of the moment because of how inexpensive it is, compared to the alternatives. Pills such as Percocet are harder to come by and more expensive.

“It takes a lot less heroin to get high than the cocaine. It’s a profitable drug to sell because you need very little,” Jacobson said.

The office of Connecticut U.S. Attorney Deirdre Daly also works with state and local law enforcement and the Drug Enforcement Administration on opioid dealing as well as “multiple overdose deaths” in the state, federal officials noted in recent statement.

“Our primary goal is to identify the source and makeup of the drugs involved,” Daly said. “This is a very serious public health issue. We will continue to prioritize the prosecution of individuals who traffic narcotics that pose significant public safety concerns.”

“Even a heroin addict is a misnomer of sorts,” Sticca said. “The addiction is to opioids: opiate-based drugs. Anything of an opioid base is what that addict is addicted to. So, all those pain medications, they’re all opiates and that’s what the addiction is. Not just a heroin addiction.”

Heroin also doesn’t carry the same stigma it did years ago, according to Sticca.

“Maybe it’s not as scary as it was years ago,” he said.

New Haven police are currently working on a way to multi-jurisdictionally look at heroin cases, including adjusting some of the department’s procedures such as evidence collection and investigation processes.

“There’s definitely more of a concerted effort,” Jacobson said.

But police efforts alone are not enough to curb drug use and deaths, Sticca said. Prevention by way of education and treating those who have addictions is paramount, he said.

“We’re not going to arrest our way out of the problem of addiction. Addiction is an illness and has to be treated as such. We go after the poisoners who are taking advantage of those people who are addicted,” Sticca said.